Video with Dr. Lee

Hands On: Improving Care in Neonatal Intensive Care Units (NICUs)

Dr. Shoo Lee and his team have introduced a new approach to NICU care called Evidence-based Practice for Improving Quality (EPIQ). 

The idea behind EPIQ is to make use of existing knowledge to improve our outcomes.

The researchers review existing studies and look at NICU practices in other countries to identify new approaches to care.

For example, the EPIQ model changes the role that parents play in NICU care.

Dr. Shoo Lee
Chief of Pediatrics
Mount Sinai Hospital

We established a program called family-integrated care, where the families are part of the care team. They provide all the care for the baby with the exception of IV medication and procedures. The nurses' role is to teach the mothers, not to care for the babies directly.

In a pilot trial, family-integrated care showed very promising results. 

We found a huge improvement in outcomes. There was a 25% improvement in weight gain. Infection rates fell from 11% to zero. Medication errors fell from 10% to zero. The babies were able to go home 10% faster, and there was an increase in satisfaction among the parents involved in this program.

The researchers will now be testing family-integrated care in a randomized controlled trial in 16 hospitals.

In another EPIQ project, the researchers addressed the problem of necrotizing enterocolitis in NICUs.

This potentially fatal infection affects 7% of low-birth-weight infants.

We learned that in Japan, the incidence was very low... 0.5%. And so we sent a team to Japan to see what they did that was different from us.

Analyzing all that information, and the information that we had from the literature, and in our own hospitals, we decided to adopt a new package of care that involved using exclusive breast milk feeding in the NICU for vulnerable babies, combined with rapid feeding so that we could remove the intravenous drips, as well as IV nutrition as quickly as possible.

Using this package of treatments, we were able to reduce the incidence of necrotizing enterocolitis in two hospitals where we tried this project from 10% to 1% within a two-year period, and it has remained so after two years. And so this is a strategy we are now going to adopt throughout the country.

The researchers are creating donor banks around the country to ensure there is a steady supply of breast milk for NICU babies.

The lessons we are learning from the collaborative care, the benefits we can gain from learning from each other are huge. And these lessons can be applied in other health care areas in this country and elsewhere, so that EPIQ potentially can be a way by which we can improve care throughout the health care system.

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